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2. We are pleased to offer our Customer Assistance Program (CAP) to those residential customers (single-family dwelling) who meet the guidelines listed below. This program provides a discount on your monthly service charge for qualified customers. Funding is limited.

4. Full Name*

   The PID water bill must be in your name.

6. Service Address*

   You must live at the address where the discount will be received.

8. PID Account Number*

   Example: "14-07845-01" - You can find your PID account number on your water bill.

10. Phone Number*

    Please enter a daytime phone number.

12. Email Address*
13. Re-Enter Your Email Address*
15. Attach a Copy of Your PG&E Bill*
17. Date on PG&E Bill You Are Uploading*
    Date on PG&E Bill You Are Uploading

    Must be a current bill within the last 45 days

19. I attest the PID water bill is in my name and I live at the address to receive the CAP discount.*

    1. I understand
21. I agree to notify PID if my household no longer qualifies for the PG&E program.*

    1. I understand
23. I understand the CAP discount will become effective the month after my application is received and approved.*

    1. I understand
25. I understand I must re-apply for this discount every three years.*

    1. I understand
27. I understand the PID Board of Directors reserves the right to make changes to the program and the amount of discount at anytime.*

    1. I understand
29. I attest the information I have provided is true and correct. I agree to inform PID if I no longer qualify for this discount. I understand that I may be required to pay back any discount I receive without qualifying for it.*

    1. I understand
31. Electronic Signature (Type Your First and Last Name)*

    By submitting your electronic signature, you attest the information provided is true and correct, you understand the terms of the application, and will notify PID if you no longer qualify under the set terms.

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field